Pretransplant Diabetes Mellitus and Obesity in Recipients Is Associated With Reduced Survival Following Donation After Circulatory Death Heart Transplantation

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BACKGROUND: This study evaluates the impact of pretransplant diabetes mellitus and obesity in recipients on outcomes following donation after circulatory death (DCD) heart transplantation. METHODS: The United Network for Organ Sharing (UNOS) registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2022. The recipients were stratified into two groups based on the presence of pretransplant diabetes mellitus. The primary outcome was 2-year post-transplant survival. Propensity score-matching was performed. Sub-analyses were performed to assess the effects of obesity and donor type. RESULTS: A total of 501 recipients were analyzed in this study. Of these, 159 (31.7%) had diabetes mellitus prior to transplantation. The diabetic recipients had substantially lower 2-year post-transplant survival compared to the non-diabetic recipients (79.9% vs. 91.4%, p < 0.001). The lower 2-year survival persisted in a propensity score-matched comparison (80.9% vs. 90.5%, p < 0.001). Furthermore, the diabetic recipients without obesity had improved survival compared to the diabetic recipients with obesity, similar to those without diabetes (84.3% vs. 76.3% vs. 91.4%, respectively; p < 0.001). Among the diabetic recipients, DCD heart transplantation was associated with a higher risk of 2-year mortality compared to donation after brain death (DBD) heart transplantation (HR 1.57, 95% CI 1.07-2.31, p = 0.021). CONCLUSIONS: Pretransplant diabetes mellitus is prevalent in nearly one-third of DCD heart transplant recipients and is associated with significantly reduced survival, particularly among those with obesity. Additionally, diabetic recipients of DCD hearts have worse outcomes compared to those receiving DBD hearts. Therefore, optimal candidate risk stratification and careful donor selection are necessary when considering heart transplantation for diabetic patients.

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